Montana Code 33-31-307. Affiliation periods
33-31-307. Affiliation periods. (1) A health maintenance organization that offers health insurance coverage in connection with a group health plan and that does not impose a preexisting condition exclusion allowed by 33-22-246 or 33-22-514 with respect to any particular coverage option may impose an affiliation period for that coverage option if:
Terms Used In Montana Code 33-31-307
- Affiliation period: means a period that, under the terms of the health insurance coverage offered by a health maintenance organization, must expire before the health insurance coverage becomes effective. See Montana Code 33-31-102
- Beneficiary: A person who is entitled to receive the benefits or proceeds of a will, trust, insurance policy, retirement plan, annuity, or other contract. Source: OCC
- Commissioner: means the commissioner of insurance of the state of Montana. See Montana Code 33-31-102
- Enrollee: means a person:
(a)who enrolls in or contracts with a health maintenance organization;
(b)on whose behalf a contract is made with a health maintenance organization to receive health care services; or
(c)on whose behalf the health maintenance organization contracts to receive health care services. See Montana Code 33-31-102
- Health care services: means :
(a)the services included in furnishing medical or dental care to a person;
(b)the services included in hospitalizing a person;
(c)the services incident to furnishing medical or dental care or hospitalization; or
(d)the services included in furnishing to a person other services for the purpose of preventing, alleviating, curing, or healing illness, injury, or physical disability. See Montana Code 33-31-102
- Health maintenance organization: means a person who provides or arranges for basic health care services to enrollees on a prepaid basis, either directly through provider employees or through contractual or other arrangements with a provider or a group of providers. See Montana Code 33-31-102
- Plan: means a health maintenance organization operated by an insurer or health service corporation as an integral part of the corporation and not as a subsidiary. See Montana Code 33-31-102
(a)the affiliation period is applied uniformly without regard to any health status-related factors; and
(b)the affiliation period does not exceed 2 months, or 3 months in the case of a late enrollee, as defined in 33-22-140.
(2)A health maintenance organization is not required to provide health care services or benefits during the affiliation period, and a premium may not be charged to the participant or beneficiary for any coverage during the affiliation period. An affiliation period begins on the enrollment date and runs concurrently with any waiting period under the plan.
(3)A health maintenance organization may use a method other than an affiliation period to address adverse selection if the method is approved by the commissioner.
(4)The definitions in 33-22-140 apply to this section.